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In response to your peers, offer feedback on their implementation and ways to improve their program proposals. 

RESPONSES FOR REVIEW

Describe your clinical experience for this week.

must be on geriatric patient 

• Did you face any challenges, any success? If so, what were they?
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Maria A

The Institute of Medicine’s (IOM) landmark 2011 report about the future and goals of nursing served as a national call to action to strengthen the nursing profession’s role in transforming healthcare. Over the past decade, the nursing community has made measurable progress in key areas, including education, clinical practice, leadership, and workforce planning. While not every target has been met, the direction and impact of the changes demonstrate the profession’s commitment to long-term systemic improvement.

One of the report’s central goals was to get an 80 % of nurses holding a Bachelor of Science in Nursing (BSN). Although the target was not fully achieved by 2020, the number of nurses with BSN degrees rose substantially due to widespread implementation of RN-to-BSN pathways, bridge programs, and collaborative academic models (Campaign for Action, 2023). The increase in doctoral-prepared nurses, particularly those pursuing the Doctor of Nursing Practice (DNP), also reflects a national trend toward advanced nursing education aligned with clinical leadership and evidence-based practice (AACN, 2021).

Equally significant is the increase of autonomous nurse practitioners (APRNs). Today, more than 25 states allow nurse practitioners to practice autonomously (AANP, 2023). This evolution in regulatory practice has helped close gaps in healthcare access, especially in rural and underserved areas, empowering APRNs to serve as primary care providers and manage chronic conditions more effectively.

Leadership in healthcare policy and administration is another area where nurses have increased their presence. Nurses are now serving on hospital boards, shaping institutional policy, and participating in health reform initiatives. These advancements reflect the implementation of DNP Essentials related to systems leadership, organizational transformation, and policy advocacy (DeNisco, 2023). Initiatives such as the Nurses on Boards Coalition have amplified the collective voice of the profession, ensuring that nurses are present where key decisions are made.

Moreover, improvements in nursing workforce data collection have enabled better planning and forecasting. Enhanced data systems have provided critical insights into geographic shortages, demographic shifts, and the need for diversity in the profession. These findings help inform policy decisions and ensure that resources are directed to the areas of highest need (National Academies of Sciences, Engineering, and Medicine, 2021).

In conclusion, this beautiful and human profession has responded to the IOM’s vision with focused, measurable efforts. Although challenges such as faculty shortages and funding gaps persist, the profession continues to evolve through education, expanded clinical roles, leadership engagement, and strategic workforce development. These achievements not only validate the recommendations made over a decade ago but also reinforce the profession’s ongoing capacity to lead change and advance health.

References

American Association of Nurse Practitioners. (2023). State practice environment. American Association of Nurse Practitioners.

Campaign for Action. (2023). Campaign maps show nurses’ progress in earning BSN degree. Campaign for Action.

DeNisco, S. M. (2023). Advanced practice nursing: Essential knowledge for the profession (5th ed.). Jones & Bartlett Learning.

National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. National Academies Press.

A 79-year-old male remarks on his first visit that he has noticed a gradual decrease in vision in both his eyes since last year. His old medical record has not yet arrived at your office. He states that since he moved from Florida a year ago, he has not had an eye examination and does not yet know an ophthalmologist. He is having difficulty carrying on his activities of daily living that involve his sight. He states that he cannot recognize people at some distance until they come quite close and he is often frightened by his perception of strangers speaking to him. Watching television and reading are becoming increasingly difficult for him. He states that glare is a problem and notes that a few times he almost tripped over something on the floor. He still drives his car in the local community. He asks if you think he may have a cataract. He says his wife had two cataracts in the past and he remembers her complaining of vision problems which have now resolved.

Vital Signs: BP 128/84; HR 82; RR 18; BMI 24.

Chief Complaint: Decrease in my vision; glare is very bothersome!

Discuss the following:

1) What additional subjective data are you seeking to include past medical history, social, and relevant family history?
2) What additional objective data will you be assessing for?
3) What are the differential diagnoses that you are considering?
4) What laboratory tests will help you rule out some of the differential diagnoses?
5) What radiological examinations or additional diagnostic studies would you order?
6) What treatment and specific information about the prescription that you will give this patient?
7) What are the potential complications from the treatment ordered?
8) What additional laboratory tests might you consider ordering?
9) What additional patient teaching may be needed?
10) Will you be looking for a consult?

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

 Javier:

Week 8 Discussion

Since the Institute of Medicine (now the National Academy of Medicine) issued “The Future of Nursing: Leading Change, Advancing Health” in 2010, the nursing profession has come a long way in implementing its recommendations. There have been many achievements, but four will be examined. First, advanced practice registered nurses (APRNs) have greatly extended practice authority in nursing (Rehka, 2020). After the report was published, many states reformed their scope-of-practice regulations to enable APRNs to practice to the full extent of their education and training. Similarly, by 2023, over half of U.S. states will allow nurse practitioners with full practice authority (eliminating physician supervision). In rural and underserved areas, where they now provide primary care, APRNs’ role in addressing these healthcare access gaps has been particularly influential in this regulatory evolution.

Second, substantial progress has been made in the proportion of nurses with baccalaureate and higher degrees. The Campaign for Nursing’s Future, set in response to the IOM report, has an ambitious goal of 80 percent of nurses holding a BSN by 2020, as per Reynolds (2024). Although this goal was not 100% realized, the percentage of nurses with a BSN has substantially increased from just over 50% in 2010 to greater than 65% in many states. The advancement of education has been fostered by the development of unique academic progression pathways, including many RN to BSN programs and partnerships with community colleges and universities, allowing for seamless education transitions.

Third, nursing’s role in healthcare redesign and policy development has grown remarkably. Nurses now occupy more executive positions in healthcare organizations, serve on hospital boards, and participate in health system governance. Started in 2014, the Nurses on Boards Coalition has helped place thousands of nurses on corporate and non-profit boards. Furthermore, nursing has amplified its voice in policy-making by facilitating boards such as the American Academy of Nursing and increased recognition in federal advisory councils (Hassmiller et al., 2020). They have also been influential in nurses’ quality improvement initiatives and have aided in decreasing hospital-acquired conditions and readmission rates by implementing evidence-based practice.

Fourth, data collection and analysis on the nursing workforce have been substantially improved. In partnership with The National Forum of State Nursing Workforce Centers, the National Council of State Boards of Nursing conducts regular, comprehensive surveys of the nursing workforce to provide critical data on supply, demand, and demographic trends. Many states have set up nursing workforce centers that gather standardized data and thus provide a more accurate prediction of future needs. At the same time, these improved data systems have enabled targeted interventions to address nursing shortages in critical specialties and geographic areas, and they have assisted in fostering diversity to create a nursing workforce that more closely reflects the population it serves.

While presenting IOM achievements, DNP Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking has stood out. Aligning with nurses’ newfound assignments in healthcare remodeling, policy engagement, and management. Nurses are now taking up executive positions and being involved in health system governance, further strengthening quality improvement and healthcare’s strategic transformation delivery (DeNisco, 2023). DNP Essential VIII: Advanced Nursing Practice was also incorporated. This essential demands a push towards higher education levels as well as seamless academic pathways like RN to BSN programs to provide for advanced clinical competency. These skills are applied by DNP-prepared nurses during complex clinical situations and they also help to mentor future nursing professionals (DeNisco, 2023). Expanded leadership roles, implementation of evidence-based practice, advanced education, and more involvement in policy development have strengthened role-specific professionalism competency and reinforced nursing’s influence and accountability in healthcare.

References

DeNisco, S. M. (2023). Advanced practice nursing: Essential knowledge for the profession. Jones & Bartlett Learning.

Hassmiller, S. B., Beauvais, A. M., & Shellenbarger, T. (2020). The Future of Nursing Report 10 years later: Where is nursing and what work remains? Nursing Education Perspectives, 41(5), 272-273.

Rekha, S. G. (2020). The future of nursing: leading change, advancing health (2020). IP J Paediatrics Nurs Sci, 3(3), 60-3.

Reynolds, L. R. (2024). Factors Impacting BSN Degrees in Community Colleges in Illinois and Exploring Community Colleges to Address Nursing Education Reform: A Mixed Methods Study (Doctoral dissertation, DePaul University).

case study

 COMPLETE the attachment after red part. Modify and fix as preferred. then read the following. 

DNP Project Hours Log 

You must submit a minimum of 45 DNP Project Hours that you completed during this course. You can use the weekly activities of this course which are directly related to your DNP Project as hours for towards your 1000 hours total needed to successfully complete this program. 

The 45 hours must Submitted in order for you grade to be posted to pass this course. 

 the clinical hours are activities related with your preparation before starting the DNP project at the end of the program, you always must describe these activities using the DNP Essentials and its activities